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Community Education: Relapse Prevention- “Doing” Recovery in this Changing World

Join licensed counselor Sandee Nebel as she reviews the impact COVID-19 is having on people’s mental health and how to support your recovery during the pandemic.

Relapse Prevention: "Doing" Recovery in this Changing World

Estimated watch time: 57 mins

Available credits: none

Presentation Materials:

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. We titled this presentation “Relapse Prevention”, and basically, in quotes, “Doing Recovery in This Changing World.”

It’s so very, very important to do a talk on relapse prevention. This is a challenging time for every single person on our planet, this is global, and if there’s any issues going on with anyone, those are going to be the things that might bubble up during this time. So “doing recovery,” I use that phrase a lot just because saying “following a recovery program” is really too strict for us. So this is just about doing recovery, keeping recovery, and a recovery focus while this world is changing around us. You’ve probably seen that it changes every day.

Okay. So this slide is about me and thank you, Alison, for introducing me. I’ll just tell you a little bit about myself and my practice. I’ve been working with people in a coaching capacity for about 22 years, helping people in recovery. I’ve been doing this work formally and as a licensed mental health counselor for 15 years. I specialize in working with all kinds of issues, but especially addiction, eating disorders, just anything that’s related. This, as you probably know, can be everything in mental health issues.

I do this through online therapy, which I have been doing since, I don’t even know. It’s been a couple of years, but I’m very grateful that I’ve been doing this since the virus erupted and we were no longer allowed to see people in our offices. Because at least I was familiar with it already, as were most of my clients. Most of my clients are what I call hybrid, or that I’ve seen some in the offices and some on video. I keep offices. My offices are in Florida and I have an office in Central Florida and in Clearwater.

So, I’ve also worked in other capacities in management of treatment centers. I told someone this morning as I gave them a direction (and it wasn’t someone to give a direction to) that, “Oops, sorry, I used to be in management and also a mom.” So there’s a part of me that’s used to being directive and every now and then in the stress of things, I forget that you really only do that in appropriate places and not to friends. So every day there’s something that I can learn from that.

I practice what’s called integrative psychotherapy. I use an integrative approach, basically meeting people where they’re at, but I always incorporate a mind-body approach, and I’ll talk about some of those things as far as tools that you can use. Towards the end of this, there’ll be some absolutely ideal tools that you can use and implement right now, because I think that’s what’s most important.

So I’ll talk about why all this is happening, what’s happening for you. I’ll give you an overview on the impact of the virus on recovery, specifically doing recovery and any of the stages of change, which you may be familiar with. I’ll talk about that. The impact of the stay-at-home orders and these are in all different levels, in all different states; strategies for coping. As I said, some very doable tools, and then some information for if you need some help.

As far as what’s happening with this virus: I’m not going to talk a whole lot about the virus specifically, because there’s places for us to have that information, mainly, the Centers for Disease Control and oftentimes your state’s websites, city websites, county websites will have some information updates that are specific to you. Fortunately or unfortunately, we don’t have national rules to go by, and so we have to keep following what our rules are locally.

This impact on recovery, as I mentioned, is for whatever stage you’ve been in. Whether what you felt was really solid recovery or that you were struggling even before this started, this has an impact. I’ll speak to specifically why and how, but the impact has been tremendous and I don’t really know of anyone that has been untouched by it.

One of the biggest things to remember about this virus and what makes it different is it’s a new form. That’s why there hasn’t been a vaccine, why there hasn’t been a cure. It’s been so unknown and so fast and so weirdly invisible that it’s been unpredictable for us. And even when I say those words, because it’s happening to us as clinicians, as therapists too, and to medical professionals.

As I talk about how the spread is rapidly growing, unseen and unpredictable, I get almost a visceral sensation in my body, this flow of anxiety. The fear and the anxiety can increase with this unknown and again, impact everyone. So I pretty much look at things like fear and anxiety on a continuum, where let’s say on a scale of zero to a hundred. You can almost picture how some of the numbers for your own anxiety might vary from day to day.

So this is what is called the stages of change. Maybe you’ve heard of this, this was started years ago, actually, for people that smoked cigarettes, to look at where they were with this, their habits/addiction. And, you know, even if you’re familiar with this, I think it’s always good to have a little bit of a re-familiarization. I look at this, the stages of change, as these could apply to almost anything. If you look at this or as I’m talking about it, you think about maybe even in a relationship or a friendship that’s been kind of up and down and you’ve been thinking about what to do with it, it applies there. If it’s about changing jobs, it can apply there. So for now we’re going to talk about it related to whatever’s going on for you and in the realm of relapse prevention.

So precontemplation is said to typically be similar to denial. So precontemplation is like if you’re just not even into making a change. It could have been yesterday. What was yesterday? Could be that day. You were thinking about making a change and then you woke up this morning and forgot. So it’s interesting how we can actually, almost like zone out and forget that this was a thought the day before.

Sometimes it’s the thought every day, especially with contemplation, where you’re starting to think about things on a regular basis where you want to make a change. And we’ll say, for example, the change might be stopping drinking alcohol. This might be something that you just think about a lot. You might, when you get to bed at night, say, “Oh, you know, I’m really thinking about it. I think I’m going to stop in the morning.” And then you start thinking about it again, and hopefully you stay consistent, but that doesn’t always happen.

So then we move on to preparation, and if we’re talking about something like alcohol (or any other kind of addiction) it could be as simple as getting rid of what’s around you. So that might mean giving away things, throwing things out, that type of thing. Maybe it’s telling people, there’s all kinds of aspects to it. Action is where you’re really doing the deal. You’ve stopped if that’s what your recovery is about, stopping drinking. You’re maybe attending some support groups or meetings. You’re maybe in the care of a physician and working with them on it, and so you’re staying in basically “being active.” Maintenance is after doing this for a time.

So hopefully you can see this on your screen okay. This is one of the better ways that I can show how the stages of change really work. So if you notice, pre-contemplation is a little bit larger because sometimes people go back and forth, back and forth, or are in denial for quite a long time. Think about yourself and how long it may have taken you to make a decision, get into recovery. Precontemplation is a little bit larger. Actions, a little bit larger and more of an optimistic way of showing that you might stay in that a little bit longer.

These actually cycle around, and if I could, I would represent it as drawing arrows all over the place because you can really jump from one to the other. You can be totally in preparation and something comes up like COVID-19 and you go back to precontemplation. Or it could be that you jumped to action and you stay there for a long time.

Relapse if you notice is looming off to the side as a cloud, which is the way that most people look at it. There’s a high percentage of relapse in every recovery. However, that doesn’t mean relapses forever, and that doesn’t mean that relapse from the past isn’t something that you’ve grown from. Actually, I really would like to call that relapse a “lapse” because depending on, you know, your perspective. It might be that you’ve had lapse for a short time, and then you regroup and you get back into recovery, which means doing some of those things that make you feel good about yourself, and not having to use your substance or your process addiction.

Relapse we normally look at as a cloud like, “Oh, I don’t want to go there, I don’t want to go there,” however, if you’ve heard some people’s stories or you think about your own, think about where you’ve grown from that. Now, I always want to say (this is my disclaimer), that doesn’t mean I’m saying, “Hey, relapse, bring it on so I can have a growth experience.” It just means this is something that you can see in your hindsight, because it’s not always a growth experience, there can be tragedy with relapse as well.

Thinking about having to stay at home, isolating, what’s the impact having on people? In presenting this, I would like to share with you that I also recognize that there are people that cannot stay at home, they have jobs where they’re serving us, people in law enforcement, working at grocery stores or other necessary businesses, certainly medical professionals and mental health professionals. This is also just how the impact of stay-at-home orders affect even maybe their work.

So talking first about isolation, as many of you know, isolation is tough. It’s one thing to be maybe a little bit introverted and you have that opportunity to regroup when you’re feeling isolated. What that would mean is, you know, that sometimes it fills you up. Staying at home, away from people, can be healing in a way: you have time to yourself. However, this is a long time, and this is a lot of it. So it’s a different kind of isolation, we almost need a new word for it. If anyone thinks of one, you know, let me know.

Staying at home, being isolated, or even taking a walk and still having to be a certain distance from other people. I don’t know if some of you have noticed, depending where you live, but taking walks, there’s so many more people out there I’ve never seen. There’s dogs that I’ve never seen before in the neighborhood. I’m sure that’s happened with you as well. Actually, I’ve even seen other animals out, but not with owners. Things like alligators, bobcats and coyotes and lots of ducks and rabbits. I’ve known these things are here for quite some time, but it’s almost like, because we are all off the streets, these animals have the opportunity to come out. And I kid you not, I’m safe though just so you know.

Isolating keeps us from the support of people, and to recover, people are a part of it. You cannot recover in a vacuum, so it’s going to be really important to take some of these things that are perceived negatively and turn them around. How can we use that and make them work for us?

Fear. Of course, stress is almost like a precursor to anxiety or can walk along anxiety, but stress is really harmful to us when it’s day after day after day. A little bit more so than if you have a stressor every now and then. Before coronavirus (I should say, BC) things like stress, you could have stress from good things as well, such as maybe a graduation or a wedding. I hesitate to say those things now because a lot of them have had to be postponed or canceled.

Financial stress is something else, and financial stress is just relative to whoever the person is. I’m seeing that more and more. It could be someone that seems to have accumulated a lot of wealth and something about this still impacts them financially and they’re still hurting, not destitute but hurting. And then of course, there are people that have lost jobs, that have lost any financial income. And then there’s everyone in between where things have gone down, businesses are struggling and everyone’s just kind of hanging in there right now, not knowing what’s next.

The psychological effects of all these stressors and what are they? Things like finding supplies. I was talking before we started the webinar today, that very early this morning when I woke up, I thought I would obsessively just (I don’t know why today) go online and start looking where I could buy toilet paper. I would like you to know that I’m not completely out and I’m not destitute, but I thought I should start looking for that. I thought I found some places that have a certain amount, so I showed up at one of the local store chains this morning where it showed that they had some, and this morning people were all waiting outside, far apart from each other, and wearing masks and gloves and pretty much standing far apart. When they opened the doors, everyone’s still clumped together, which kind of defeated the purpose. Going in there was people mainly going for medications and things that they needed, and it didn’t matter. The toilet paper wasn’t there anyway, and the truck hadn’t come in, but just the stress from that, you know, it was, it was just very, very stressful.

People were talking outside how stressful it was for them and, you know, bothered by other people. So there’s been a lot of people, agitated by other people and things like this as well. So anyway, you know, my thought was “I don’t really need it yet” and “I’m not supposed to have it” and “I will deal with it,” and by that time, my hope is that it’s replenished in the stores or online.

Frustration and boredom. Frustration is the biggest feeling that I hear people talk about along with boredom. As we all know, when we were young and we maybe told our families or caregivers that we were bored, our families, they’re not necessarily saying, “Oh, well here, do this, do that.” unless it was a chore. That wasn’t the kind of response that we wanted. So we’re bored and kind of finding things that really interest us, activating the brain chemistry, especially the dopamine. For people that have either used food, drugs or alcohol, or even process addictions such as gambling or gaming, those kinds of things so stimulated the brain that the boredom might come a little easier now, almost a little faster. Compare it with the boredom when you were young and there were other things to do or needed to be done, meaning inside the home and outside the home as well.

We are very frustrated by having insufficient information. And I think that it’s also getting to people. When do you tune in to news? When, where, who do you listen to? How do you find out what to do? Like I said in the beginning, doing something like checking your city’s local website, county and/or state. All of the above, not just Facebook.

And the other thing that’s getting to us, a lot, these are, I think the five biggest keys, but is how the quarantine is extended and it seems to go on and on and we don’t know when things will change, and we just know, okay, it’s two weeks, two weeks, and then it’s a little bit longer. So I’m finding (I’m going to see how I can just make sure I’m muting everyone. Okay, got it.) So having that unknown is very uncomfortable for us and we all have it. I don’t know too many people that are happy with it.

Like I mentioned in my story this morning, having fears of either getting sick or infecting others. As someone that’s trained in dealing with emotions and people, I was more so watching people this morning as they were standing away from each other or talking about, you know, different fears. Of course I’m human, I feel things as well. But, you know, I hope I’m working on being a little bit more comfortable with the discomfort, as I’ll talk about.

There’s some stressors that we’re all going to have and we’re anticipating now post-quarantine. Whatever’s going to happen financially, and whatever’s going to happen jobwise. And if it’s not about your job, maybe you’re retired or maybe, your job is still going on, but how things might change.

When I say stigma, there’s some stigma and some judgment about different groups of people: people starting this, people having had the virus and then being around again. They’re afraid of a stigma because they might be judged or people might stay away from them for a longer period of time.

And then we’re worried about and don’t know what it’s going to look like when the biggest part of this is behind us. When we’re hoping things get back to some kind of normal, and it sounds like it’ll be a new normal.

So what’s really important is to see what’s going on. These are some of the strategies (tools will come later, specific tools). Some of the strategies: looking with compassion on the impact on our communities. Whether it’s your family, your friends, you know, our culture, society globally, everyone’s job security, here’s just so much loss. So you could be financially perfectly intact, but feeling a sense of loss: loss of freedom, loss of the ability to go where you want to and not be barricaded from certain areas, loss of community. To know that most people head towards a negative way of thinking in this, and we have to work on staying optimistic.

So let’s talk about coming and bringing it home, meaning to yourselves. So the way to healing, including the recovery process, is through self-compassion. Knowing, first of all, that you’re going to have stress. Being aware and dealing with your anxiety. Knowing that it’s going to be hard to focus and concentrate. I don’t know how many people have told me they have a goal of reading, of doing certain things like artwork, organizing all kinds of things and that it’s been very hard for them to stay focused.

Especially if you have an issue in recovery, and you’re in recovery or trying to stay or be in the recovery process, focusing and concentrating is very hard. Ironically, what is needed is to be able to be clear of your substance, or if it’s about food, eating the appropriate amounts nutritionally so that it can help you concentrate. (Excuse me, when I just, if everyone can mute themselves if I haven’t? Let me do this. There we go. I think now you can’t unmute. So sorry. I took away another freedom, that’ll come back to you though, I promise.)

So, dealing with grief and loss, knowing that a lot of what you’re feeling is grief, because what we all have is loss. That helps sometimes because we use words like “I’m depressed, or I’m in a depression,” and it’s really important to examine: is it a depression or are you grieving? Because, it’s really, really appropriate to be grieving now, and everyone does this in their own way, and it’s not like you’re depressed or you’re not. There’s varying degrees of depression. So being able to identify where that is can help you a lot.

So, you’re not all or nothing, depressed or not depressed. Knowing you’re going to be frustrated and you’re going to be uncomfortable. Also, some people respond to traumatic events like we’re all going through with hypervigilance, where they’re really looking around, they’re noticing every single person, they’re noticing what’s happening and they’re very attuned to the news, and that could be getting to you as well.

So I want to give you some strategies so you have some things that you can use. Some of these may sound like no-brainers, that you should know them, or you do know them. I think they’re good reminders. They’ve been good reminders for me in reviewing this presentation.

Things like: staying informed. Now, this doesn’t mean, like I said, with the hypervigilance that you’re watching the news every moment and exploring everything all the time. It means that you are just maybe looking at the news once a day or two times a day. I tend to advise you not to do it much more than that. You want to stay informed of what you need to do in your community. Also, when we have information on what is going on, as well as what this disease is exactly. As much as we have access to, we do better. This helps us psychologically, the research shows that when we’re informed of anything we do better, we respond better. So having a plan with family or friends or people that you’re connected to with things that you might need or anything that you have to prepare. Once again, I’m sure you’ve heard it many, many times for practicing healthy hygiene precautions.

So I’ll briefly tell my story of my placebo wipes I’ve been using. Oh, I should have them here to hold them up, but I’ve always used hand wipes. I don’t particularly like the scent of most of the hand sanitizers, and so I use hand wipes. Well, I haven’t liked the sense of some new hand wipe that was out that I was using or my brand changed too. So then I went online and I found them unscented and I was very excited. For, I don’t know, about a year or two years, I’ve been ordering them by the box and keep them in my car. I keep them wherever, use them. Maybe if I come out of the gym or the supermarket, and I use these hand wipes.

Well, when everything’s said that the ingredients need to show something with alcohol in them of a type that is a cleaner, or that we need to use Clorox or ammonia or that type of thing, or Lysol to clean. I looked at the ingredients in my hand wipes and what the label says on it, which is pretty much in big letters, but they’re white. I’ll just say they’re white on a green background and it says, use these wipes instead of water. So they’ve had no soap in them, no ingredients that actually have been cleaning anything, but I’ve been using them for quite a while and I don’t know, I’m very prone to the placebo effect, really works well on me. But, I thought it was funny when I saw these hand wipes were like that, but I’m still using them. So, I’m using other things as well now and washing my hands a lot, so I recommend that as well.

Of course: practicing social distancing. It doesn’t mean just like getting a group and being six feet apart. It really means staying home and when you have to go somewhere being six feet apart. Last week I saw at a place where I’ve taken walks where there’s a bay, and I had never seen so many boats in this water area, and the people were in the water, they were talking to each other, they were all hanging out. Then it’s come out as an emergency warning, at least in this area, that boats have to have a certain distance from each other. So people were trying to actually buck the system and do those things, and you know, that can’t be done either. So now waterways are having to be patrolled in a different way for social distancing.

This is for all of us, if you ever hear anyone that’s a healthcare worker right now, especially in a hospital, they just think that it’s appalling that we are not doing this. That’s just a good reminder for us. We’re not, you know, bad people, but we need to do the right things for ourselves and everyone.

So working with, I always call these the four pillars of health. These are types of things that I talked to clients and patients about. These are people that have addictions with drugs and other substances. These are people that have addiction to alcohol. These are people that have issues with food, either too much, too little exercise, and people that are very stimulated by gaming and other things. So I just like to go through these because again, this is a great way, if nothing else, this is a great way to think because we need to kind of juggle these. It’s never going to be all perfect, but these are where we can set some of our own personal goals to have true health and to be the healthiest we can be.

So when I say nutrition: the right amount of food, the right foods, and the right intervals. If you need help with that, the doctors are busy now, but you can contact dieticians. Try to just be as balanced as you can because that will definitely impact your health and especially your thinking.

Movement: just the right amount of movement. For some people that may be not at all, and for others it’s moving more. My daughter lives in New York City and she’s been talking about how she, basically (because they have little apartments in New York City) moves from the bed to the couch, to the bed, to the couch. She’s a teacher. She’s doing online teaching, and she said to me in a text last week, she said, “What are bedsores? Because I think I’m getting them from sitting around.” So then, she decided she needed some movement, and then I explained when people do have that in hospitals and things, they do turn over, they do move a little. So, funny/not funny, but that was you know, one of the things that brought a little humor to last week because of just not moving much. Having the appropriate-for-you amount of movement, and that can even be dancing. In fact, dancing is great.

Working with your thoughts: especially I’ll talk about that. Not having the all-or-nothing thinking. Because it’s either we’re sick or we’re not sick. That’s not true. There are degrees to being sick, healthy, not healthy. In recovery, it might be a little bit clearer for you, or maybe not, it might be blurry.

And lastly: talking about rest. So I say rest, that includes relaxation; that includes something restorative; and yes, that includes sleep. Your sleep may have changed for better or for worse during this period, but the medical guidelines now are showing that as adults, we need between eight and nine hours of sleep. So if you’re someone that gets eight to nine hours of sleep, if you have access here to raise your hand or note in the questions or anything like that, I want to know. Most people talk about getting anywhere, well the average probably being six. So this is an opportunity to maybe dial up what you’re doing. You never want to go from six to saying, “Oh, I’m going to sleep nine hours.” That will probably not be successful. Work on it slowly.

Something restful and relaxing is something that most of us aren’t too familiar with, and that may be one of the issues with staying home. Doing something restorative and restful means actually not being on electronics unless you’re using an app that’s playing a guided imagery for relaxation. I always say that we have two speeds that we were all operating on: busy and asleep, and not knowing how to do the rest. It’s like we need more yoga to counteract all the coffee that has been drunk over the years. So really, again, working on that, and I’ll give you some ideas.

When we talk about thoughts and emotions, talking about relapse thinking or moving towards relapse or recovery thinking and moving towards and staying in recovery, these are some relapsed-type of thoughts. That all-or-nothing thinking I mentioned before is going to the worst-case scenario in your mind, in your thoughts, maybe talking about it. What if, what if this, what if that? I will say there’s a lot of people that come to me as a counselor and talk about how they really believe that if they think through what the worst-case scenario is, they can then visualize that this is better than that. It might be a superstition that, “Oh, then that won’t happen.” So for now, my suggestion is like over the next month or so, let go of those superstitions and let go of picturing the worst-case scenario.

“Ruminating” is about thoughts. Typically we think about the same things today as we thought about yesterday. We dwell on the same kind of thoughts. Of course, there’s been some new ones during this period of time, but we pretty much have some of the same thoughts over and over. Just start to look at that, just be aware of it. Almost like witnessing your thoughts can help that. It’s dangerous for us to stay focused on threat. It’s going to be a place where you go from time to time, but again, being aware of this.

I will say that one of the biggest things (well, I say there’s two here) that can get you in trouble and bring your thinking all the way back to ground zero, and not in a good way. Ground zero is back to almost like precontemplation and denial, it’s self-deprecating thoughts and statements. So a lot of you may have been doing that all your life. When people have self-deprecating thoughts as part of their regular thinking they typically have done it for a very long time. A self-deprecating thought would be a self put-down. To some of you, I may have said it too directly because I’ve been saying it a lot lately. One great thing to weave into your recovery and to abstain from is ever saying that to yourselves, “I am stupid.” Just letting go of that, losing that whole statement. Working on one thing at a time like that, but knowing that may be where your thoughts go first. My suggestion with all of these thoughts is acknowledge the thought and then go to your second thought.

So the last line you can put in any word that you like best. I felt like this wasn’t a good place to write any curse words or things, but sometimes with the all-or-nothing thinking, people say, and I’ll just say maybe one of the easiest of them, which is like, “heck with it.” They get the heck, or I’ll go a little deeper, “screw it.” And that might be because they feel like they’re not doing something perfectly, and you do not have to wait until the end of the day or a week that begins with Monday or the first of the month. Oh, today’s the first of the month, but you know, it doesn’t matter. Just pick right back up with your recovery.

If it’s about food, it’s the next meal, if it’s about alcohol or drugs, it’s that next moment. So you actually work on your recovery the next moment. You don’t wait until you have a birthday that ends in a zero or something to change what you’re doing. So this can be really helpful. As I was talking about some of the hurtful thoughts, the all-or-nothing thinking is not how to manage your thoughts in recovery.

Stay present. I’m sure many of you have heard this, but I do this hand motion, don’t know if you can see it, but it’s just bringing things back to the present moment. So as soon as you find your mind wanders and you start dwelling on what’s going to happen or what did happen, work on bringing it back into the present. There are times where you have to plan, of course, or you have to look at your history, but for the most part right now, just staying present, being where your hands are. Focus on what you do have control over, not what you don’t.

Maybe attach yourself to some slogans or mantras, and these are the kinds of things that are easy to stay with you-. If you don’t remember them that well, use post-it notes and post them all over or wherever you can, or on your home screen or your electronics. Things like “easy does it,” things like “one day at a time.” I mean, those are the first things that just came into my mind and they’re pretty much typical for me and they help. A mantra might help you, too. Saying something that’s a phrase or a word over and over might help you, when you need it. It doesn’t work to stay in a present moment that’s maybe really uncomfortable. Use some thought distraction. If you’re overly focused on what’s going to happen next and staying in fear, maybe decide to think about something. It might be that you decide to think about a positive project you’re working on or something that you’re excited about to happen, or how you might get that way. Again, stay in awareness versus staying in fear.

So there’s going to be things that we all fear at this time, and just being aware of it and just bringing it back to, ”Oh, that was a thought, a fearful thought, or a fearful feeling.” When I say “think senses every now and then”: if you find yourself troubled, start to think about, “What do I see? What colors do I see? What do I taste? What’s the taste in my mouth? What do I smell?” Going through your senses, it’s not only a distraction, but it might bring you to something that is a helpful thought for you. Again, utilizing self-compassion versus self-deprecation or self-condemnation, self-compassion. There’s some good resources online. Self-compassion.org has some good things about seeking support.

So your support will likely look very, very different right now, I know mine does, everyone’s does. Your support may not be about gathering together in groups anymore. However, I have seen and heard from people that they’ve utilized zoom to have gatherings with family in so many different places. I think more people are actually reaching out, and they set their mind to it and seek these relationships out, even to ask how someone is. It’s really great to use your support network and seek meetings, things like that, things like this that you can find and that would be helpful to you.

So this is my area of expertise as a licensed therapist, and that is working with feelings. Of course, I don’t ever say to people, “How does that make you feel?” I would never say that. Any of you have worked with me you know I don’t say that, I don’t even think it. However, this is a time to look at what we’re feeling. There’s always a feeling inside. Some of you that might be thinking “Umm, no. You know, I try to stay away from feelings. I’m more of a thought person.” Well, if you’re more of a thought person, take one hand, place it over your heart, place the other over your abdomen. You’re thinking and feeling, you’re feeling places. And just sit with that for a minute and maybe think about what you’re feeling. Let’s take a second and do that now. Just one hand over your heart, the other over your abdomen.

Notice any feelings. Name them, label them, affirm them. Validate them. Oh, okay. So I’m feeling, I’ll just say excited. So named it, identified it and it’s fine for me to feel excited. So then how do we move to self-soothing those feelings? Well, if you’re relapsing or in lapse or relapse, then you might be working on self-soothing through whatever your addiction or issue is that’s popped up. Find some healthy ways to self-soothe, and I don’t name things typically like a bath or massage or anything. I think it needs some concrete things that you can use by yourself at any time, you can’t take a bath at any time.

Shift your thoughts and feelings to a giving perspective. So a lot of times, you know, we’re thinking about what’s been done to me, especially during this time, feeling victimized. Victimized as a world, as a country, as a member of a community, or even in your family. Shifting your perspective to more giving, helping others in some way, whatever that is for you. And just doing one thing at a time. Not burning yourself out with it, but something so you can shift your feelings to something different.

And of course, in recovery, this is talked about a lot, but expectations, managing expectations. What is the phrase? The slogan is “expectations are actually premeditated resentments.”

Harriet Lerner has a quote, she’s written many, many books on the dance of anger and some others that are really very useful and really great reading. She says, “Only through our connectedness to others can we really know and enhance the self, and only through working on the self can we begin to enhance our connectedness.”

So working on and “spreading your wings to cultivate connection.” Spreading your wings means just expanding your scope in this case. If it’s about the community: taking walks, saying hello to people, even if you’re six feet away or more, you can still wave, you can still say hello. Like I said before, zoom support groups, Facetiming with people. I know people have gone back to things like Words With Friends (a phone app) and things like that to stay connected. Actually using the telephone. I, from time to time, actually forget that the telephone works in a way other than texting or reading my emails, that we can actually talk on it. So calling people and talking to them and asking them how they’re doing. Sometimes I may not. I have a couple of people in my life that are actually really, really funny, and so they’re fun to call. So if you have a call that you have to make to maybe a relative and you don’t feel like it’s going to be very much fun, maybe call someone that is fun beforehand.

Facebook groups are amazing. There’s groups for everything. There’s groups for people that work with different kinds of… what are those called? That? Oh, the gel pens that have been out for, I don’t know, 20 years or something. People that make drawings with gel pens, there’s every kind of art group. There’s all kinds of recovery groups. Looking into Facebook groups, I think is the best part of Facebook, you really can build a community.

When it comes to yourself: because this is very important to connect with the self, even though you feel like disconnecting right now. At times, actually reflect on some things, taking some time to reflect. You might do that through journaling, or you might just put yourself in a yoga pose with your legs up the wall, or sitting still in a chair and centering. Maybe it’s taking some magazines you have in your home or something else, or printing some things out online and creating a collage. Anything to bring your perspective back to where you’re at. It’s actually an opportunity to reflect right now.

Seek support. If you’re in a program where you can have a sponsor or a mentor, you can seek one out and help your peers that are in recovery. Contact newcomers, people that are just getting in there. Even if you have one day in recovery, you have something to offer, and if you’ve been someone that relapsed on and off throughout your life, you also have something to give. You didn’t unlearn what you’ve learned all that time.

Make sure that you have a counselor or a therapist to work with. There’s a lot of free services now, and it’ll be talked about at the end of this webinar what offerings there might be for some of these services and support. Work with maybe a life coach or a health coach, medical support if needed, psychiatric support, if needed, and again, that support community. If you are having issues with work, talking to peers in a way that’s healthy and along the lines of what your work suggests. At least, if everyone’s working at home, talking about some of the issues with working at home. I saw someone post on social media, “What’s your work-at-home outfit look like?”, and I saw a lot of pajamas and comfy clothes. So maybe contacting colleagues if you’re in some kind of a professional role, seeing what other people are doing. Again, maybe talking to your manager about some of the questions you’re having. Utilizing HR and an employee assistance program at your work if you have it.

So I’d like to take a little bit of time just to go through these tools. We’re very close to the end, and these are tools that I suggest you find your favorites in. So, whether it’s working with the breathe, which is always with us, or some guided imagery (and there’s some fabulous apps that are out there that you can utilize for guided imagery). Some progressive muscle relaxation, doing some yoga. I’m going to jump around here. I say “play” on here, but play like, have fun with some things, not just a game and not just an electronic game, but playing with something and laughing. When I say affirmations, I don’t just mean going around saying, “I’m okay, I’m okay” or some version of that. Affirming your thoughts, whatever they are, neutralizing your thoughts, looking at where your strengths are. Helping other people. Setting boundaries that are helpful to you. Boundaries where you don’t have a wall up and boundaries where you’re not taking everyone in. Something in between that’s healthy for you.

All of this, there on the left column says “resilience.” All of this will help build resilience. We’re all becoming more resilient in this, and that’s not like we want to say “bring it on,” but that’s a side benefit that’s happening here. Finding our purpose and our meaning. Your individual purpose. What really thrills you about maybe making art? Maybe it’s been writing stories. Maybe it’s been doing some household projects that you either didn’t know you were good at or, or you’re just getting done. Find some things that are meaningful to you. Maybe it’s creating a room that’s your own, and your house, and sticking with your values. So, really, I want to go back to the first five that are there.

So a lot of yoga studios are now offering free classes online. Looking into that, there can be a yoga studio that’s in your area or I’ve had several people tell me that they actually went on the website of a yoga studio. They loved when they lived either up North or out West or some other place, and that they were able to access classes from the place that they really missed and really had their yoga heart. So, maybe finding some classes in that.

You can always stop them. You know, if it’s something that you feel like is not for you, then you don’t have to go through with the whole thing. You can stop something, midway. I was in a class last week where at the end, the speaker, who is actually adopted, was telling us that there were people doing yoga from Australia and Singapore at that moment with that class. They were in that class.

I strongly suggest that you look into the top four, which are some breathing exercises. By breathing exercises, it could just be focusing on slowing down your exhale. You inhale normally, slowing the exhale. So taking a breath in, we can all take a breath in. Now, and slowly exhale. One more in, slow down the exhale. Very slowly.

So I’ve done some of these things with groups where people will check their smartwatch and see their heart rate. They could actually see how they got more and more relaxed. So these are awesome tools. I’m trying to leave this up a little longer, if you want to make any notes of any of them to pursue.
If you do need any help, reach out. Don’t wait. Of course, in an emergency call 911, contact treatment centers, work with counselors and therapists. There’s a lot of free services right now, or some things that you can learn about online. Talk to family, talk to friends, maybe heal some of those relationships. Clearly access your support groups. So many, if not all of them are online. Don’t wait. Get your help early.

Thank you for watching this video. We hope you enjoyed the presentation.

Objectives and Summary:

In this community education webinar, Sandee Nebel, LMHC, discusses the impact the COVID-19 pandemic is having on people’s mental health and recovery process, and then reviews different strategies, tools and resources to manage stress and meet your emotional health needs.

After watching her presentation, the viewer will be able to:
  1. Understand the different stressors, thought processes and experiences COVID-19 brings up and how they impact a person’s recovery and mental health
  2. Access a series of strategies to practice self-compassion, combat stress and change all-or-nothing thinking
  3. Name examples of resources available for support, guidance and relaxation

Presentation Materials:

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. We titled this presentation “Relapse Prevention”, and basically, in quotes, “Doing Recovery in This Changing World.”

It’s so very, very important to do a talk on relapse prevention. This is a challenging time for every single person on our planet, this is global, and if there’s any issues going on with anyone, those are going to be the things that might bubble up during this time. So “doing recovery,” I use that phrase a lot just because saying “following a recovery program” is really too strict for us. So this is just about doing recovery, keeping recovery, and a recovery focus while this world is changing around us. You’ve probably seen that it changes every day.

Okay. So this slide is about me and thank you, Alison, for introducing me. I’ll just tell you a little bit about myself and my practice. I’ve been working with people in a coaching capacity for about 22 years, helping people in recovery. I’ve been doing this work formally and as a licensed mental health counselor for 15 years. I specialize in working with all kinds of issues, but especially addiction, eating disorders, just anything that’s related. This, as you probably know, can be everything in mental health issues.

I do this through online therapy, which I have been doing since, I don’t even know. It’s been a couple of years, but I’m very grateful that I’ve been doing this since the virus erupted and we were no longer allowed to see people in our offices. Because at least I was familiar with it already, as were most of my clients. Most of my clients are what I call hybrid, or that I’ve seen some in the offices and some on video. I keep offices. My offices are in Florida and I have an office in Central Florida and in Clearwater.

So, I’ve also worked in other capacities in management of treatment centers. I told someone this morning as I gave them a direction (and it wasn’t someone to give a direction to) that, “Oops, sorry, I used to be in management and also a mom.” So there’s a part of me that’s used to being directive and every now and then in the stress of things, I forget that you really only do that in appropriate places and not to friends. So every day there’s something that I can learn from that.

I practice what’s called integrative psychotherapy. I use an integrative approach, basically meeting people where they’re at, but I always incorporate a mind-body approach, and I’ll talk about some of those things as far as tools that you can use. Towards the end of this, there’ll be some absolutely ideal tools that you can use and implement right now, because I think that’s what’s most important.

So I’ll talk about why all this is happening, what’s happening for you. I’ll give you an overview on the impact of the virus on recovery, specifically doing recovery and any of the stages of change, which you may be familiar with. I’ll talk about that. The impact of the stay-at-home orders and these are in all different levels, in all different states; strategies for coping. As I said, some very doable tools, and then some information for if you need some help.

As far as what’s happening with this virus: I’m not going to talk a whole lot about the virus specifically, because there’s places for us to have that information, mainly, the Centers for Disease Control and oftentimes your state’s websites, city websites, county websites will have some information updates that are specific to you. Fortunately or unfortunately, we don’t have national rules to go by, and so we have to keep following what our rules are locally.

This impact on recovery, as I mentioned, is for whatever stage you’ve been in. Whether what you felt was really solid recovery or that you were struggling even before this started, this has an impact. I’ll speak to specifically why and how, but the impact has been tremendous and I don’t really know of anyone that has been untouched by it.

One of the biggest things to remember about this virus and what makes it different is it’s a new form. That’s why there hasn’t been a vaccine, why there hasn’t been a cure. It’s been so unknown and so fast and so weirdly invisible that it’s been unpredictable for us. And even when I say those words, because it’s happening to us as clinicians, as therapists too, and to medical professionals.

As I talk about how the spread is rapidly growing, unseen and unpredictable, I get almost a visceral sensation in my body, this flow of anxiety. The fear and the anxiety can increase with this unknown and again, impact everyone. So I pretty much look at things like fear and anxiety on a continuum, where let’s say on a scale of zero to a hundred. You can almost picture how some of the numbers for your own anxiety might vary from day to day.

So this is what is called the stages of change. Maybe you’ve heard of this, this was started years ago, actually, for people that smoked cigarettes, to look at where they were with this, their habits/addiction. And, you know, even if you’re familiar with this, I think it’s always good to have a little bit of a re-familiarization. I look at this, the stages of change, as these could apply to almost anything. If you look at this or as I’m talking about it, you think about maybe even in a relationship or a friendship that’s been kind of up and down and you’ve been thinking about what to do with it, it applies there. If it’s about changing jobs, it can apply there. So for now we’re going to talk about it related to whatever’s going on for you and in the realm of relapse prevention.

So precontemplation is said to typically be similar to denial. So precontemplation is like if you’re just not even into making a change. It could have been yesterday. What was yesterday? Could be that day. You were thinking about making a change and then you woke up this morning and forgot. So it’s interesting how we can actually, almost like zone out and forget that this was a thought the day before.

Sometimes it’s the thought every day, especially with contemplation, where you’re starting to think about things on a regular basis where you want to make a change. And we’ll say, for example, the change might be stopping drinking alcohol. This might be something that you just think about a lot. You might, when you get to bed at night, say, “Oh, you know, I’m really thinking about it. I think I’m going to stop in the morning.” And then you start thinking about it again, and hopefully you stay consistent, but that doesn’t always happen.

So then we move on to preparation, and if we’re talking about something like alcohol (or any other kind of addiction) it could be as simple as getting rid of what’s around you. So that might mean giving away things, throwing things out, that type of thing. Maybe it’s telling people, there’s all kinds of aspects to it. Action is where you’re really doing the deal. You’ve stopped if that’s what your recovery is about, stopping drinking. You’re maybe attending some support groups or meetings. You’re maybe in the care of a physician and working with them on it, and so you’re staying in basically “being active.” Maintenance is after doing this for a time.

So hopefully you can see this on your screen okay. This is one of the better ways that I can show how the stages of change really work. So if you notice, pre-contemplation is a little bit larger because sometimes people go back and forth, back and forth, or are in denial for quite a long time. Think about yourself and how long it may have taken you to make a decision, get into recovery. Precontemplation is a little bit larger. Actions, a little bit larger and more of an optimistic way of showing that you might stay in that a little bit longer.

These actually cycle around, and if I could, I would represent it as drawing arrows all over the place because you can really jump from one to the other. You can be totally in preparation and something comes up like COVID-19 and you go back to precontemplation. Or it could be that you jumped to action and you stay there for a long time.

Relapse if you notice is looming off to the side as a cloud, which is the way that most people look at it. There’s a high percentage of relapse in every recovery. However, that doesn’t mean relapses forever, and that doesn’t mean that relapse from the past isn’t something that you’ve grown from. Actually, I really would like to call that relapse a “lapse” because depending on, you know, your perspective. It might be that you’ve had lapse for a short time, and then you regroup and you get back into recovery, which means doing some of those things that make you feel good about yourself, and not having to use your substance or your process addiction.

Relapse we normally look at as a cloud like, “Oh, I don’t want to go there, I don’t want to go there,” however, if you’ve heard some people’s stories or you think about your own, think about where you’ve grown from that. Now, I always want to say (this is my disclaimer), that doesn’t mean I’m saying, “Hey, relapse, bring it on so I can have a growth experience.” It just means this is something that you can see in your hindsight, because it’s not always a growth experience, there can be tragedy with relapse as well.

Thinking about having to stay at home, isolating, what’s the impact having on people? In presenting this, I would like to share with you that I also recognize that there are people that cannot stay at home, they have jobs where they’re serving us, people in law enforcement, working at grocery stores or other necessary businesses, certainly medical professionals and mental health professionals. This is also just how the impact of stay-at-home orders affect even maybe their work.

So talking first about isolation, as many of you know, isolation is tough. It’s one thing to be maybe a little bit introverted and you have that opportunity to regroup when you’re feeling isolated. What that would mean is, you know, that sometimes it fills you up. Staying at home, away from people, can be healing in a way: you have time to yourself. However, this is a long time, and this is a lot of it. So it’s a different kind of isolation, we almost need a new word for it. If anyone thinks of one, you know, let me know.

Staying at home, being isolated, or even taking a walk and still having to be a certain distance from other people. I don’t know if some of you have noticed, depending where you live, but taking walks, there’s so many more people out there I’ve never seen. There’s dogs that I’ve never seen before in the neighborhood. I’m sure that’s happened with you as well. Actually, I’ve even seen other animals out, but not with owners. Things like alligators, bobcats and coyotes and lots of ducks and rabbits. I’ve known these things are here for quite some time, but it’s almost like, because we are all off the streets, these animals have the opportunity to come out. And I kid you not, I’m safe though just so you know.

Isolating keeps us from the support of people, and to recover, people are a part of it. You cannot recover in a vacuum, so it’s going to be really important to take some of these things that are perceived negatively and turn them around. How can we use that and make them work for us?

Fear. Of course, stress is almost like a precursor to anxiety or can walk along anxiety, but stress is really harmful to us when it’s day after day after day. A little bit more so than if you have a stressor every now and then. Before coronavirus (I should say, BC) things like stress, you could have stress from good things as well, such as maybe a graduation or a wedding. I hesitate to say those things now because a lot of them have had to be postponed or canceled.

Financial stress is something else, and financial stress is just relative to whoever the person is. I’m seeing that more and more. It could be someone that seems to have accumulated a lot of wealth and something about this still impacts them financially and they’re still hurting, not destitute but hurting. And then of course, there are people that have lost jobs, that have lost any financial income. And then there’s everyone in between where things have gone down, businesses are struggling and everyone’s just kind of hanging in there right now, not knowing what’s next.

The psychological effects of all these stressors and what are they? Things like finding supplies. I was talking before we started the webinar today, that very early this morning when I woke up, I thought I would obsessively just (I don’t know why today) go online and start looking where I could buy toilet paper. I would like you to know that I’m not completely out and I’m not destitute, but I thought I should start looking for that. I thought I found some places that have a certain amount, so I showed up at one of the local store chains this morning where it showed that they had some, and this morning people were all waiting outside, far apart from each other, and wearing masks and gloves and pretty much standing far apart. When they opened the doors, everyone’s still clumped together, which kind of defeated the purpose. Going in there was people mainly going for medications and things that they needed, and it didn’t matter. The toilet paper wasn’t there anyway, and the truck hadn’t come in, but just the stress from that, you know, it was, it was just very, very stressful.

People were talking outside how stressful it was for them and, you know, bothered by other people. So there’s been a lot of people, agitated by other people and things like this as well. So anyway, you know, my thought was “I don’t really need it yet” and “I’m not supposed to have it” and “I will deal with it,” and by that time, my hope is that it’s replenished in the stores or online.

Frustration and boredom. Frustration is the biggest feeling that I hear people talk about along with boredom. As we all know, when we were young and we maybe told our families or caregivers that we were bored, our families, they’re not necessarily saying, “Oh, well here, do this, do that.” unless it was a chore. That wasn’t the kind of response that we wanted. So we’re bored and kind of finding things that really interest us, activating the brain chemistry, especially the dopamine. For people that have either used food, drugs or alcohol, or even process addictions such as gambling or gaming, those kinds of things so stimulated the brain that the boredom might come a little easier now, almost a little faster. Compare it with the boredom when you were young and there were other things to do or needed to be done, meaning inside the home and outside the home as well.

We are very frustrated by having insufficient information. And I think that it’s also getting to people. When do you tune in to news? When, where, who do you listen to? How do you find out what to do? Like I said in the beginning, doing something like checking your city’s local website, county and/or state. All of the above, not just Facebook.

And the other thing that’s getting to us, a lot, these are, I think the five biggest keys, but is how the quarantine is extended and it seems to go on and on and we don’t know when things will change, and we just know, okay, it’s two weeks, two weeks, and then it’s a little bit longer. So I’m finding (I’m going to see how I can just make sure I’m muting everyone. Okay, got it.) So having that unknown is very uncomfortable for us and we all have it. I don’t know too many people that are happy with it.

Like I mentioned in my story this morning, having fears of either getting sick or infecting others. As someone that’s trained in dealing with emotions and people, I was more so watching people this morning as they were standing away from each other or talking about, you know, different fears. Of course I’m human, I feel things as well. But, you know, I hope I’m working on being a little bit more comfortable with the discomfort, as I’ll talk about.

There’s some stressors that we’re all going to have and we’re anticipating now post-quarantine. Whatever’s going to happen financially, and whatever’s going to happen jobwise. And if it’s not about your job, maybe you’re retired or maybe, your job is still going on, but how things might change.

When I say stigma, there’s some stigma and some judgment about different groups of people: people starting this, people having had the virus and then being around again. They’re afraid of a stigma because they might be judged or people might stay away from them for a longer period of time.

And then we’re worried about and don’t know what it’s going to look like when the biggest part of this is behind us. When we’re hoping things get back to some kind of normal, and it sounds like it’ll be a new normal.

So what’s really important is to see what’s going on. These are some of the strategies (tools will come later, specific tools). Some of the strategies: looking with compassion on the impact on our communities. Whether it’s your family, your friends, you know, our culture, society globally, everyone’s job security, here’s just so much loss. So you could be financially perfectly intact, but feeling a sense of loss: loss of freedom, loss of the ability to go where you want to and not be barricaded from certain areas, loss of community. To know that most people head towards a negative way of thinking in this, and we have to work on staying optimistic.

So let’s talk about coming and bringing it home, meaning to yourselves. So the way to healing, including the recovery process, is through self-compassion. Knowing, first of all, that you’re going to have stress. Being aware and dealing with your anxiety. Knowing that it’s going to be hard to focus and concentrate. I don’t know how many people have told me they have a goal of reading, of doing certain things like artwork, organizing all kinds of things and that it’s been very hard for them to stay focused.

Especially if you have an issue in recovery, and you’re in recovery or trying to stay or be in the recovery process, focusing and concentrating is very hard. Ironically, what is needed is to be able to be clear of your substance, or if it’s about food, eating the appropriate amounts nutritionally so that it can help you concentrate. (Excuse me, when I just, if everyone can mute themselves if I haven’t? Let me do this. There we go. I think now you can’t unmute. So sorry. I took away another freedom, that’ll come back to you though, I promise.)

So, dealing with grief and loss, knowing that a lot of what you’re feeling is grief, because what we all have is loss. That helps sometimes because we use words like “I’m depressed, or I’m in a depression,” and it’s really important to examine: is it a depression or are you grieving? Because, it’s really, really appropriate to be grieving now, and everyone does this in their own way, and it’s not like you’re depressed or you’re not. There’s varying degrees of depression. So being able to identify where that is can help you a lot.

So, you’re not all or nothing, depressed or not depressed. Knowing you’re going to be frustrated and you’re going to be uncomfortable. Also, some people respond to traumatic events like we’re all going through with hypervigilance, where they’re really looking around, they’re noticing every single person, they’re noticing what’s happening and they’re very attuned to the news, and that could be getting to you as well.

So I want to give you some strategies so you have some things that you can use. Some of these may sound like no-brainers, that you should know them, or you do know them. I think they’re good reminders. They’ve been good reminders for me in reviewing this presentation.

Things like: staying informed. Now, this doesn’t mean, like I said, with the hypervigilance that you’re watching the news every moment and exploring everything all the time. It means that you are just maybe looking at the news once a day or two times a day. I tend to advise you not to do it much more than that. You want to stay informed of what you need to do in your community. Also, when we have information on what is going on, as well as what this disease is exactly. As much as we have access to, we do better. This helps us psychologically, the research shows that when we’re informed of anything we do better, we respond better. So having a plan with family or friends or people that you’re connected to with things that you might need or anything that you have to prepare. Once again, I’m sure you’ve heard it many, many times for practicing healthy hygiene precautions.

So I’ll briefly tell my story of my placebo wipes I’ve been using. Oh, I should have them here to hold them up, but I’ve always used hand wipes. I don’t particularly like the scent of most of the hand sanitizers, and so I use hand wipes. Well, I haven’t liked the sense of some new hand wipe that was out that I was using or my brand changed too. So then I went online and I found them unscented and I was very excited. For, I don’t know, about a year or two years, I’ve been ordering them by the box and keep them in my car. I keep them wherever, use them. Maybe if I come out of the gym or the supermarket, and I use these hand wipes.

Well, when everything’s said that the ingredients need to show something with alcohol in them of a type that is a cleaner, or that we need to use Clorox or ammonia or that type of thing, or Lysol to clean. I looked at the ingredients in my hand wipes and what the label says on it, which is pretty much in big letters, but they’re white. I’ll just say they’re white on a green background and it says, use these wipes instead of water. So they’ve had no soap in them, no ingredients that actually have been cleaning anything, but I’ve been using them for quite a while and I don’t know, I’m very prone to the placebo effect, really works well on me. But, I thought it was funny when I saw these hand wipes were like that, but I’m still using them. So, I’m using other things as well now and washing my hands a lot, so I recommend that as well.

Of course: practicing social distancing. It doesn’t mean just like getting a group and being six feet apart. It really means staying home and when you have to go somewhere being six feet apart. Last week I saw at a place where I’ve taken walks where there’s a bay, and I had never seen so many boats in this water area, and the people were in the water, they were talking to each other, they were all hanging out. Then it’s come out as an emergency warning, at least in this area, that boats have to have a certain distance from each other. So people were trying to actually buck the system and do those things, and you know, that can’t be done either. So now waterways are having to be patrolled in a different way for social distancing.

This is for all of us, if you ever hear anyone that’s a healthcare worker right now, especially in a hospital, they just think that it’s appalling that we are not doing this. That’s just a good reminder for us. We’re not, you know, bad people, but we need to do the right things for ourselves and everyone.

So working with, I always call these the four pillars of health. These are types of things that I talked to clients and patients about. These are people that have addictions with drugs and other substances. These are people that have addiction to alcohol. These are people that have issues with food, either too much, too little exercise, and people that are very stimulated by gaming and other things. So I just like to go through these because again, this is a great way, if nothing else, this is a great way to think because we need to kind of juggle these. It’s never going to be all perfect, but these are where we can set some of our own personal goals to have true health and to be the healthiest we can be.

So when I say nutrition: the right amount of food, the right foods, and the right intervals. If you need help with that, the doctors are busy now, but you can contact dieticians. Try to just be as balanced as you can because that will definitely impact your health and especially your thinking.

Movement: just the right amount of movement. For some people that may be not at all, and for others it’s moving more. My daughter lives in New York City and she’s been talking about how she, basically (because they have little apartments in New York City) moves from the bed to the couch, to the bed, to the couch. She’s a teacher. She’s doing online teaching, and she said to me in a text last week, she said, “What are bedsores? Because I think I’m getting them from sitting around.” So then, she decided she needed some movement, and then I explained when people do have that in hospitals and things, they do turn over, they do move a little. So, funny/not funny, but that was you know, one of the things that brought a little humor to last week because of just not moving much. Having the appropriate-for-you amount of movement, and that can even be dancing. In fact, dancing is great.

Working with your thoughts: especially I’ll talk about that. Not having the all-or-nothing thinking. Because it’s either we’re sick or we’re not sick. That’s not true. There are degrees to being sick, healthy, not healthy. In recovery, it might be a little bit clearer for you, or maybe not, it might be blurry.

And lastly: talking about rest. So I say rest, that includes relaxation; that includes something restorative; and yes, that includes sleep. Your sleep may have changed for better or for worse during this period, but the medical guidelines now are showing that as adults, we need between eight and nine hours of sleep. So if you’re someone that gets eight to nine hours of sleep, if you have access here to raise your hand or note in the questions or anything like that, I want to know. Most people talk about getting anywhere, well the average probably being six. So this is an opportunity to maybe dial up what you’re doing. You never want to go from six to saying, “Oh, I’m going to sleep nine hours.” That will probably not be successful. Work on it slowly.

Something restful and relaxing is something that most of us aren’t too familiar with, and that may be one of the issues with staying home. Doing something restorative and restful means actually not being on electronics unless you’re using an app that’s playing a guided imagery for relaxation. I always say that we have two speeds that we were all operating on: busy and asleep, and not knowing how to do the rest. It’s like we need more yoga to counteract all the coffee that has been drunk over the years. So really, again, working on that, and I’ll give you some ideas.

When we talk about thoughts and emotions, talking about relapse thinking or moving towards relapse or recovery thinking and moving towards and staying in recovery, these are some relapsed-type of thoughts. That all-or-nothing thinking I mentioned before is going to the worst-case scenario in your mind, in your thoughts, maybe talking about it. What if, what if this, what if that? I will say there’s a lot of people that come to me as a counselor and talk about how they really believe that if they think through what the worst-case scenario is, they can then visualize that this is better than that. It might be a superstition that, “Oh, then that won’t happen.” So for now, my suggestion is like over the next month or so, let go of those superstitions and let go of picturing the worst-case scenario.

“Ruminating” is about thoughts. Typically we think about the same things today as we thought about yesterday. We dwell on the same kind of thoughts. Of course, there’s been some new ones during this period of time, but we pretty much have some of the same thoughts over and over. Just start to look at that, just be aware of it. Almost like witnessing your thoughts can help that. It’s dangerous for us to stay focused on threat. It’s going to be a place where you go from time to time, but again, being aware of this.

I will say that one of the biggest things (well, I say there’s two here) that can get you in trouble and bring your thinking all the way back to ground zero, and not in a good way. Ground zero is back to almost like precontemplation and denial, it’s self-deprecating thoughts and statements. So a lot of you may have been doing that all your life. When people have self-deprecating thoughts as part of their regular thinking they typically have done it for a very long time. A self-deprecating thought would be a self put-down. To some of you, I may have said it too directly because I’ve been saying it a lot lately. One great thing to weave into your recovery and to abstain from is ever saying that to yourselves, “I am stupid.” Just letting go of that, losing that whole statement. Working on one thing at a time like that, but knowing that may be where your thoughts go first. My suggestion with all of these thoughts is acknowledge the thought and then go to your second thought.

So the last line you can put in any word that you like best. I felt like this wasn’t a good place to write any curse words or things, but sometimes with the all-or-nothing thinking, people say, and I’ll just say maybe one of the easiest of them, which is like, “heck with it.” They get the heck, or I’ll go a little deeper, “screw it.” And that might be because they feel like they’re not doing something perfectly, and you do not have to wait until the end of the day or a week that begins with Monday or the first of the month. Oh, today’s the first of the month, but you know, it doesn’t matter. Just pick right back up with your recovery.

If it’s about food, it’s the next meal, if it’s about alcohol or drugs, it’s that next moment. So you actually work on your recovery the next moment. You don’t wait until you have a birthday that ends in a zero or something to change what you’re doing. So this can be really helpful. As I was talking about some of the hurtful thoughts, the all-or-nothing thinking is not how to manage your thoughts in recovery.

Stay present. I’m sure many of you have heard this, but I do this hand motion, don’t know if you can see it, but it’s just bringing things back to the present moment. So as soon as you find your mind wanders and you start dwelling on what’s going to happen or what did happen, work on bringing it back into the present. There are times where you have to plan, of course, or you have to look at your history, but for the most part right now, just staying present, being where your hands are. Focus on what you do have control over, not what you don’t.

Maybe attach yourself to some slogans or mantras, and these are the kinds of things that are easy to stay with you-. If you don’t remember them that well, use post-it notes and post them all over or wherever you can, or on your home screen or your electronics. Things like “easy does it,” things like “one day at a time.” I mean, those are the first things that just came into my mind and they’re pretty much typical for me and they help. A mantra might help you, too. Saying something that’s a phrase or a word over and over might help you, when you need it. It doesn’t work to stay in a present moment that’s maybe really uncomfortable. Use some thought distraction. If you’re overly focused on what’s going to happen next and staying in fear, maybe decide to think about something. It might be that you decide to think about a positive project you’re working on or something that you’re excited about to happen, or how you might get that way. Again, stay in awareness versus staying in fear.

So there’s going to be things that we all fear at this time, and just being aware of it and just bringing it back to, ”Oh, that was a thought, a fearful thought, or a fearful feeling.” When I say “think senses every now and then”: if you find yourself troubled, start to think about, “What do I see? What colors do I see? What do I taste? What’s the taste in my mouth? What do I smell?” Going through your senses, it’s not only a distraction, but it might bring you to something that is a helpful thought for you. Again, utilizing self-compassion versus self-deprecation or self-condemnation, self-compassion. There’s some good resources online. Self-compassion.org has some good things about seeking support.

So your support will likely look very, very different right now, I know mine does, everyone’s does. Your support may not be about gathering together in groups anymore. However, I have seen and heard from people that they’ve utilized zoom to have gatherings with family in so many different places. I think more people are actually reaching out, and they set their mind to it and seek these relationships out, even to ask how someone is. It’s really great to use your support network and seek meetings, things like that, things like this that you can find and that would be helpful to you.

So this is my area of expertise as a licensed therapist, and that is working with feelings. Of course, I don’t ever say to people, “How does that make you feel?” I would never say that. Any of you have worked with me you know I don’t say that, I don’t even think it. However, this is a time to look at what we’re feeling. There’s always a feeling inside. Some of you that might be thinking “Umm, no. You know, I try to stay away from feelings. I’m more of a thought person.” Well, if you’re more of a thought person, take one hand, place it over your heart, place the other over your abdomen. You’re thinking and feeling, you’re feeling places. And just sit with that for a minute and maybe think about what you’re feeling. Let’s take a second and do that now. Just one hand over your heart, the other over your abdomen.

Notice any feelings. Name them, label them, affirm them. Validate them. Oh, okay. So I’m feeling, I’ll just say excited. So named it, identified it and it’s fine for me to feel excited. So then how do we move to self-soothing those feelings? Well, if you’re relapsing or in lapse or relapse, then you might be working on self-soothing through whatever your addiction or issue is that’s popped up. Find some healthy ways to self-soothe, and I don’t name things typically like a bath or massage or anything. I think it needs some concrete things that you can use by yourself at any time, you can’t take a bath at any time.

Shift your thoughts and feelings to a giving perspective. So a lot of times, you know, we’re thinking about what’s been done to me, especially during this time, feeling victimized. Victimized as a world, as a country, as a member of a community, or even in your family. Shifting your perspective to more giving, helping others in some way, whatever that is for you. And just doing one thing at a time. Not burning yourself out with it, but something so you can shift your feelings to something different.

And of course, in recovery, this is talked about a lot, but expectations, managing expectations. What is the phrase? The slogan is “expectations are actually premeditated resentments.”

Harriet Lerner has a quote, she’s written many, many books on the dance of anger and some others that are really very useful and really great reading. She says, “Only through our connectedness to others can we really know and enhance the self, and only through working on the self can we begin to enhance our connectedness.”

So working on and “spreading your wings to cultivate connection.” Spreading your wings means just expanding your scope in this case. If it’s about the community: taking walks, saying hello to people, even if you’re six feet away or more, you can still wave, you can still say hello. Like I said before, zoom support groups, Facetiming with people. I know people have gone back to things like Words With Friends (a phone app) and things like that to stay connected. Actually using the telephone. I, from time to time, actually forget that the telephone works in a way other than texting or reading my emails, that we can actually talk on it. So calling people and talking to them and asking them how they’re doing. Sometimes I may not. I have a couple of people in my life that are actually really, really funny, and so they’re fun to call. So if you have a call that you have to make to maybe a relative and you don’t feel like it’s going to be very much fun, maybe call someone that is fun beforehand.

Facebook groups are amazing. There’s groups for everything. There’s groups for people that work with different kinds of… what are those called? That? Oh, the gel pens that have been out for, I don’t know, 20 years or something. People that make drawings with gel pens, there’s every kind of art group. There’s all kinds of recovery groups. Looking into Facebook groups, I think is the best part of Facebook, you really can build a community.

When it comes to yourself: because this is very important to connect with the self, even though you feel like disconnecting right now. At times, actually reflect on some things, taking some time to reflect. You might do that through journaling, or you might just put yourself in a yoga pose with your legs up the wall, or sitting still in a chair and centering. Maybe it’s taking some magazines you have in your home or something else, or printing some things out online and creating a collage. Anything to bring your perspective back to where you’re at. It’s actually an opportunity to reflect right now.

Seek support. If you’re in a program where you can have a sponsor or a mentor, you can seek one out and help your peers that are in recovery. Contact newcomers, people that are just getting in there. Even if you have one day in recovery, you have something to offer, and if you’ve been someone that relapsed on and off throughout your life, you also have something to give. You didn’t unlearn what you’ve learned all that time.

Make sure that you have a counselor or a therapist to work with. There’s a lot of free services now, and it’ll be talked about at the end of this webinar what offerings there might be for some of these services and support. Work with maybe a life coach or a health coach, medical support if needed, psychiatric support, if needed, and again, that support community. If you are having issues with work, talking to peers in a way that’s healthy and along the lines of what your work suggests. At least, if everyone’s working at home, talking about some of the issues with working at home. I saw someone post on social media, “What’s your work-at-home outfit look like?”, and I saw a lot of pajamas and comfy clothes. So maybe contacting colleagues if you’re in some kind of a professional role, seeing what other people are doing. Again, maybe talking to your manager about some of the questions you’re having. Utilizing HR and an employee assistance program at your work if you have it.

So I’d like to take a little bit of time just to go through these tools. We’re very close to the end, and these are tools that I suggest you find your favorites in. So, whether it’s working with the breathe, which is always with us, or some guided imagery (and there’s some fabulous apps that are out there that you can utilize for guided imagery). Some progressive muscle relaxation, doing some yoga. I’m going to jump around here. I say “play” on here, but play like, have fun with some things, not just a game and not just an electronic game, but playing with something and laughing. When I say affirmations, I don’t just mean going around saying, “I’m okay, I’m okay” or some version of that. Affirming your thoughts, whatever they are, neutralizing your thoughts, looking at where your strengths are. Helping other people. Setting boundaries that are helpful to you. Boundaries where you don’t have a wall up and boundaries where you’re not taking everyone in. Something in between that’s healthy for you.

All of this, there on the left column says “resilience.” All of this will help build resilience. We’re all becoming more resilient in this, and that’s not like we want to say “bring it on,” but that’s a side benefit that’s happening here. Finding our purpose and our meaning. Your individual purpose. What really thrills you about maybe making art? Maybe it’s been writing stories. Maybe it’s been doing some household projects that you either didn’t know you were good at or, or you’re just getting done. Find some things that are meaningful to you. Maybe it’s creating a room that’s your own, and your house, and sticking with your values. So, really, I want to go back to the first five that are there.

So a lot of yoga studios are now offering free classes online. Looking into that, there can be a yoga studio that’s in your area or I’ve had several people tell me that they actually went on the website of a yoga studio. They loved when they lived either up North or out West or some other place, and that they were able to access classes from the place that they really missed and really had their yoga heart. So, maybe finding some classes in that.

You can always stop them. You know, if it’s something that you feel like is not for you, then you don’t have to go through with the whole thing. You can stop something, midway. I was in a class last week where at the end, the speaker, who is actually adopted, was telling us that there were people doing yoga from Australia and Singapore at that moment with that class. They were in that class.

I strongly suggest that you look into the top four, which are some breathing exercises. By breathing exercises, it could just be focusing on slowing down your exhale. You inhale normally, slowing the exhale. So taking a breath in, we can all take a breath in. Now, and slowly exhale. One more in, slow down the exhale. Very slowly.

So I’ve done some of these things with groups where people will check their smartwatch and see their heart rate. They could actually see how they got more and more relaxed. So these are awesome tools. I’m trying to leave this up a little longer, if you want to make any notes of any of them to pursue.
If you do need any help, reach out. Don’t wait. Of course, in an emergency call 911, contact treatment centers, work with counselors and therapists. There’s a lot of free services right now, or some things that you can learn about online. Talk to family, talk to friends, maybe heal some of those relationships. Clearly access your support groups. So many, if not all of them are online. Don’t wait. Get your help early.

Thank you for watching this video. We hope you enjoyed the presentation.

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